| (g) No walking problem. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 2.
Walking up and down stairs.
Note: when both walking
and stairs apply, only one score (the highest) can count.
|
2 (a) Cannot walk up and down
one stair. |
15 |
| (b) Cannot walk up and down a
flight of 12 stairs. |
15 |
| (c) Cannot walk up and down a
flight of 12 stairs without holding on and taking a rest. |
7 |
| (d) Cannot walk up and down a
flight of 12 stairs without holding on. |
3 |
| (e) Can only walk up and down a
flight of 12 stairs if s/he goes side-ways or one step at a time. |
3 |
| (f) No problem in walking up and
down stairs. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 3.
Sitting in an upright chair with a back, but no arms. |
3 (a) Cannot sit comfortably. |
15 |
| (b) Cannot sit comfortably for
more than 10 minutes without having to move from the chair because the
degree of discomfort makes it impossible to continue sitting. |
15 |
| (c) Cannot sit comfortably for
more than 30 minutes without having to move from the chair because the
degree of discomfort makes it impossible to continue sitting. |
7 |
| (d) Cannot sit comfortably for
more than 1 hour without having to move from the chair because the
degree of discomfort makes it impossible to continue sitting. |
3 |
| (e) Cannot sit comfortably for
more than 2 hours without having to move from the chair because the
degree of discomfort makes it impossible to continue sitting. |
0 |
| (f) No problem with sitting. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 4.
Standing without the support of another person or the use of an aid
except a walking stick. |
4 (a) Cannot stand unassisted. |
15 |
| (b) Cannot stand for more than
a minute before needing to sit down. |
15 |
| (c) Cannot stand for more than
10 minutes before needing to sit down. |
15 |
| (d) Cannot stand for more than
30 minutes before needing to sit down. |
7 |
| (e) Cannot stand for more than
10 minutes before needing to move around. |
7 |
| (f) Cannot stand for more than
30 minutes before needing to move around. |
3 |
| (g) No problem standing. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 5. Rising from
sitting in an upright chair with a back but no arms without the help of
another person. |
5 (a) Cannot rise
from sitting to standing. |
15 |
| (b) Cannot rise from sitting to
standing without holding on to something. |
7 |
| (c) Sometimes cannot rise from
sitting to standing without holding on to something. |
3 |
| (d) No problem with rising from
sitting to standing. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 6. Bending and
kneeling. |
6 (a) Cannot bend to touch
her/his knees and straighten up. |
15 |
| (b) Cannot either bend or kneel
or bend and kneel as if to pick up a piece of paper from the floor and
straighten up again. |
15 |
| (c) Sometimes cannot either bend
or kneel or bend and kneel as if to pick up a piece of paper from the
floor and straighten up again. |
3 |
| (d) No problem with bending and
kneeling. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 7. Manual
dexterity. |
7 (a) Cannot turn the
pages of a book with either hand. |
15 |
| (b) Cannot turn a sink tap or
the control knobs on a cooker with either hand. |
15 |
| (c) Cannot pick up a coin which
is 2.5 centimetres or less in diameter with either hand. |
15 |
| (d) Cannot use a pen or pencil. |
15 |
| (e) Cannot tie a bow in laces or
string. |
10 |
| (f) Cannot turn a sink tap or
the control knobs on a cooker with one hand but can with the other. |
6 |
| (g) Cannot pick up a coin which
is 2.5 centimetres or less in diameter with one hand but can with the
other. |
6 |
| (h) No problem with manual
dexterity. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 8. Lifting and
carrying by use of the upper body and arms (excluding all other
activities specified in Part I.) |
8 (a) Cannot pick
up a paper-back book with either hand. |
15 |
| (b) Cannot pick up and carry a
0.5 litre carton of milk with either hand. |
15 |
| (c) Cannot pick up and pour from
a full saucepan or kettle of 1.7 litre capacity with either hand. |
15 |
| (d) Cannot pick up and carry a
2.5 kilogramme bag of potatoes with either hand. |
8 |
| (e) Cannot pick up and carry a
0.5 litre carton of milk with one hand but can with the other. |
6 |
| (f) Cannot pick up and carry a
2.5 kilogramme bag of potatoes with one hand but can with the other. |
0 |
| (g) No problem with lifting and
carrying. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 9. Reaching |
9 (a) Cannot raise either
arm as if to put something in the top pocket of a coat or jacket. |
15 |
| (b) Cannot raise either arm to
her/his head as if to put on a hat. |
15 |
| (c) Cannot put either arm behind
back as if to put on a coat or jacket. |
15 |
| (d) Cannot raise either arm
above her/his head as if to reach for something. |
15 |
| (e) Cannot raise one arm to
her/his head as if to put on a hat but can with the other. |
6 |
| (f) Cannot raise one arm above
her/his head as if to reach for something but can with the other. |
0 |
| (g) No problem with reaching. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 10. Speech. |
10 (a) Cannot speak. |
15 |
| (b) Speech cannot be understood
by family or friends. |
15 |
| (c) Speech cannot be understood
by strangers. |
15 |
| (d) Strangers have great
difficulty understanding speech. |
10 |
| (e) Strangers have some
difficulty understanding speech. |
8 |
| (f) No problems with speech. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 11. Hearing with a
hearing aid or other aid if normally worn. |
11 (a) Cannot hear sounds at
all. |
15 |
| (b) Cannot hear well enough to
follow a television programme with the volume turned up. |
15 |
| (c) Cannot hear well enough to
understand someone talking in a loud voice in a quiet room. |
15 |
| (d) Cannot hear well enough to
understand someone talking in a normal voice in a quiet room. |
10 |
| (e) Cannot hear well enough to
understand someone talking in a normal voice on a busy street. |
8 |
| (f) No problem with hearing. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 12. Vision in normal
daylight or bright electric light with glasses or other aid to vision if
such aid is normally worn. |
12 (a) Cannot tell light from
dark. |
15 |
| (b) Cannot see the shape of
furniture in the room. |
15 |
| (c) Cannot see well enough to
read 16 point print at a distance greater than 20 centimetres. |
15 |
| (d) Cannot see well enough to
recognise a friend across the room at a distance of at least 5 metres. |
12 |
| (e) Cannot see well enough to
recognise a friend across the road at a distance of at least 15 metres. |
8 |
| (f) No problem with vision. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 13. Continence
(other than enuresis [bedwetting].) |
13 (a) No voluntary control over
bowels. |
15 |
| (b) No voluntary control over
bladder. |
15 |
| (c) Loses control of bowels at
least once a week. |
15 |
| (d) Loses control of bowels at
least once a month. |
15 |
| (e) Loses control of bowels
occasionally. |
9 |
| (f) Loses control of bladder at
least once a month. |
3 |
| (g) Loses control of bladder
occasionally. |
0 |
| (h) No problem with continence. |
0 |
| (1) Activity |
(2) Descriptor |
(3) Points |
| 14.
Remaining conscious without having
epileptic or similar seizures during waking moments. |
14 (a) Has an involuntary
episode of lost or altered consciousness at least once a
day. |
15 |
| (b) Has an involuntary episode
of lost or altered consciousness at least once a week. |
15 |
| (c) Has an involuntary episode
of lost or altered consciousness at least once a month. |
15 |
| (d) Has had an involuntary
episode of lost or altered consciousness at least twice in the 6 months
before the day in respect to which it falls to be determined whether
s/he is incapable of work for the purposes of entitlement to any
benefit, allowance or advantage. |
12 |
| (e) Has had an involuntary
episode of lost or altered consciousness once in the 6 months before the
day in respect to which it falls to be determined whether s/he is
incapable of work for the purposes of entitlement to any benefit,
allowance or advantage. |
8 |
| (f) Has had an involuntary
episode of lost or altered consciousness once in the 3 years before the
day in respect to which it falls to be determined whether s/he is
incapable of work for the purposes of entitlement to any benefit,
allowance or advantage. |
0 |
| (g) Has no problems with
consciousness. |
0 |
| |